title: Abnormal cervical cytology risk factors in the Western Black Sea Region and the importance of health insurance.
abstract: OBJECTIVE
  To evaluate the prevalence of abnormal cervical cytological findings in the Western Black Sea Region and investigate an association between socio-demographic risk factors and the presence of cytological abnormalities.
  
  
  METHODS
  The reports of 11,539 cervical smears diagnosed according to Bethesda System 2001 version in the Pathology Department between January 2011 and December 2012 were reviewed retrospectively from the hospital records and cytopathology reports. Repeated smear results, unsatisfactory smear results, patients with known gynecologic malignancy history, smear results of patients with hysterectomy and smear results of patients whose socio-demographic information could not be obtained were excluded from the evaluation. The results of 7,740 patients who met the criteria for the study were evaluated.
  
  
  RESULTS
  The prevalence of cervical cytological abnormalities was 1.8 % in general. The prevalence rates for atypical squamous cells with undetermined significance (ASC-US), atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), and atypical glandular cells (AGC) were 1.16%, 0.11%, 0.29%, 0.15%, and 0.03% respectively. The prevalence of cytologically diagnosed cervical invasive neoplasia was 0.025%. Advanced age, low education level (primary school or less) and not having health insurance were found as to be risk factors for preinvasive and invasive lesions. Women who had a high school education and previously had a smear test had decreased risk for developing preinvasive and invasive lesions.
  
  
  CONCLUSIONS
  This study shows prevalence of abnormal cervical cytology findings and associated risk factors in the Western Black Sea Region of Turkey. The most important risk factor was identified as not having health insurance.
authors.affiliation: Department of Obstetric and Gynecology, Pamukkale University, Faculty of Medicine, DENİZLİ, TURKEY.
authors.forename: Serap
authors.initials: S
authors.lastname: Sımavli
authors.forename: Ikbal
authors.initials: I
authors.lastname: Kaygusuz
authors.forename: Selma
authors.initials: S
authors.lastname: Cukur
authors.forename: Ferda
authors.initials: F
authors.lastname: Aksel
mesh_terms: D000328:Adult; D000367:Age Factors; D059038:Black Sea; D004522:Educational Status; D005260:Female; D006801:Humans; D007348:Insurance, Health; D017057:Medically Uninsured; D008875:Middle Aged; D060787:Neoplasm Grading; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014421:Turkey / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control